Current Oncology Reports

, Volume 8, Issue 1, pp 22–28

Bone integrity and bone metastases in breast cancer

Article

Abstract

Individuals with a history of early-stage breast cancer may be at increased risk of osteoporosis related to adjuvant therapy, and those with metastatic breast cancer may experience skeletal-related complications from the cancer affecting the bone. Maintaining bone strength is critical in the care of both early- and late-stage breast cancer patients because fractures are associated with morbidity and mortality. This article reviews the maintenance of bone integrity in women with breast cancer.

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References and Recommended Reading

  1. 1.
    Body JJ: Effectiveness and cost of bisphosphonate therapy in tumor bone disease. Cancer 2003, 97(3 Suppl):859–865. The impact of bisphosphonate therapy on SREs is summarized, and outstanding issues are outlined as areas for future research with a particular emphasis on cost analysis.PubMedCrossRefGoogle Scholar
  2. 2.
    Roodman GD: Mechanisms of bone metastasis. N Engl J Med 2004, 350:1655–1664. The state-of-the-art information on bone metastases is outlined in this paper.PubMedCrossRefGoogle Scholar
  3. 3.
    NIH consensus development panel on osteoporosis prevention, diagnosis and therapy. JAMA 2001, 285:785–795.Google Scholar
  4. 4.
    Raisz LG: Clinical practice: screening for osteoporosis. N Engl J Med 2005, 353:164–171. The state-of-the-art information on screening for osteoporosis in the general population is outlined in this paper.PubMedCrossRefGoogle Scholar
  5. 5.
    Dawson-Hughes B, Bonner FJ Jr, Gold DT, et al. (Development Committee): Physician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation; 2003. http://www.nof.org.Google Scholar
  6. 6.
    American Association of Clinical Endocrinologists (AACE):Medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003, 9:544–564.Google Scholar
  7. 7.
    Nelson HD, Helfand M, Woolf SH, et al.: Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002, 137:529–541.PubMedGoogle Scholar
  8. 8.
    Miller PD, Barlas S, Brenneman SK, et al.: Approach to identifying osteopenic women at increased short-term risk of fracture. Arch Intern Med 2004, 164:1113–1120.PubMedCrossRefGoogle Scholar
  9. 9.
    Siris ES, Chen Y-T, Abbot TA, et al.: Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 2004, 164:1108–1112.PubMedCrossRefGoogle Scholar
  10. 10.
    Schousboe JT, Nyman JA, Kane RL, Ensrud KE: Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 2005, 142:734–741.PubMedGoogle Scholar
  11. 11.
    Hoff AO, Gagel RF: Osteoporosis in breast and prostate cancer survivors. Oncology (Huntington) 2005, 19:651–658.Google Scholar
  12. 12.
    Greep NC, Giuliano AE, Hansen NM, et al.: The effects of adjuvant chemotherapy on bone density in postmenopausal women with early breast cancer. Am J Med 2003, 114:653–659.PubMedCrossRefGoogle Scholar
  13. 13.
    Chen Z, Maricic M, Bassford TL, et al.: Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 2005, 165:552–558.PubMedCrossRefGoogle Scholar
  14. 14.
    Winer EP, Hudis C, Burstein HJ, et al.: American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women With hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 2005, 23:619–629. ASCO statement on the use of aromatase inhibitors in women with hormone receptor-positive early-stage breast cancer.PubMedCrossRefGoogle Scholar
  15. 15.
    Ramaswamy B, Shapiro CL: Osteopenia and osteoporosis in women with breast cancer. Semin Oncol 2003, 30:763–775.PubMedCrossRefGoogle Scholar
  16. 16.
    ATAC Trialists’ Group: Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 2005, 365:60–62.CrossRefGoogle Scholar
  17. 17.
    Hillner BE, Ingle JN, Chlebowski RT, et al.: American Society of Clinical Oncology 2003 update on the role of bisphosphonates and the bone health issues in women with breast cancer. J Clin Oncol 2003, 21:4042–4057. ASCO guidelines for the medical oncologist’s use of bisphosphonates in women with a history of breast cancer or with active breast cancer and bone metastases.PubMedCrossRefGoogle Scholar
  18. 18.
    Brufsky A, Harker W, Beck J, et al.: Zoledronic acid (ZA) effectively inhibits cancer treatment-induced bone loss (CTIBL) in postmenopausal women (PMW) with early breast cancer (BCa) receiving adjuvant letrozole (Let): 12 mos BMD results of the Z-FAST trial [abstract 533]. Proc ASCO 2005, 23:12s.Google Scholar
  19. 19.
    Gnant M, Jakesz R, Mlineritsch B, et al.: Zoledronic acid effectively counteracts cancer treatment induced bone loss (CTIBL) in premenopausal breast cancer patients receiving adjuvant endocrine treatment with goserelin plus anastrozole versus goserelin plus tamoxifen — bone density subprotocol results of a randomized multicenter trial (ABCSG-12) [abstract 6]. Breast Cancer Res Treat 2004, 88(Suppl1):S8-S9.Google Scholar
  20. 20.
    Garnero P, Srnay-Rendu E, Claustrat B, et al.: Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res, 2000, 15:1526–1536.PubMedCrossRefGoogle Scholar
  21. 21.
    Rosen CJ: Clinical practice. Postmenopausal osteoporosis. N Engl J Med 2005, 353:595–603. The state-of-the-art information on postmenopausal osteoporosis in the general population is outlined in this paper.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Regan RM, Gajdos C, Dardes RC, et al.: Effects of raloxifene after tamoxifen on breast and endometrial tumor growth in athymic mice. J Natl Cancer Inst 2002, 94:274–283. Provocative preclinical data raising concerns for the use of serial SERMs.PubMedGoogle Scholar
  23. 23.
    Zujewski J, Eng-Wong J, Reynolds J, et al.: A phase 2 trial of raloxifene in premenopausal women at high risk for developing invasive breast cancer. Breast Cancer Res Treat, 2002, 76(Suppl):abstract 417.Google Scholar
  24. 24.
    Black DM, Bilezikian JP, Ensrud KE, et al.: PaTH Study Investigators. One year of alendronate after one year of parathyroid hormone (1-84) for osteoporosis. N Engl J Med 2005, 353:555–565.PubMedCrossRefGoogle Scholar
  25. 25.
    Cosman F, Nieves J, Zion M, et al.: Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med 2005, 353:566–575.PubMedCrossRefGoogle Scholar
  26. 26.
    Van Poznak C, Sauter S: Clinical management of osteoporosis in women with a history of breast cancer. Cancer 2005, 104:443–456.PubMedCrossRefGoogle Scholar
  27. 27.
    Odvina CV, Zerwekh JE, Rao DS, et al.: Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005, 90:1294–1301. Provocative paper addressing the potential for bisphosphonate therapy inducing a hypodynamic state in bone.PubMedCrossRefGoogle Scholar
  28. 28.
    Ruggiero SL, Mehortra B, Rosenberg TJ, Engroff SL: Osteonecrosis of the jaw associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004, 62:527–534. A large case series of patients diagnosed with osteonecrosis of the jaw after exposure to either intravenous or oral bisphosphonate therapy.PubMedCrossRefGoogle Scholar
  29. 29.
    Coleman RE, Smith P, Rubens RD: Clinical course and prognostic factors following recurrence from breast cancer. Br J Cancer, 1998, 77:336–340.PubMedGoogle Scholar
  30. 30.
    Mirels H: Metastatic disease in long bones: a proposed scoring system for diagnosis impending pathological fracture. Clin Orthop Rel Res 1989, 249:256–261.Google Scholar
  31. 31.
    Hipp JA, Springfield DS, Hayes WC: Predicting pathologic fracture risk in the management of metastatic bone defects. Clin Orthop 1995, 312:120–135.PubMedGoogle Scholar
  32. 32.
    Lipton A: Management of bone metastases in breast cancer. Curr Treat Opt Oncol 2005, 6:161–171.Google Scholar
  33. 33.
    Body JJ, Diel IJ, Lichinitzer M, et al.: Oral ibandronate reduces the risk of skeletal complications in breast cancer patients with metastatic bone disease: results from two randomised, placebo-controlled phase III studies. Br J Cancer 2004, 90:1133–1137.PubMedCrossRefGoogle Scholar
  34. 34.
    Body JJ, Diel IJ, Lichinitser MR, et al.: Intravenous ibandronate reduces the incidence of skeletal complications in patients with breast cancer and bone metastases. Ann Oncol 2003, 14:1399–1405.PubMedCrossRefGoogle Scholar
  35. 35.
    Durie BGM, Woo S-B, Maerevoet D, et al.: Osteonecrosis of the jaw and bisphosphonates [correspondence]. N Engl J Med 2005, 353:99–102. Internet survey with self-reporting of osteonecrosis of the jaw by patients with breast cancer and multiple myeloma and exposure to bisphosphonate therapy.PubMedCrossRefGoogle Scholar
  36. 36.
    Van Poznak CH, Estilo CL, Sauter NP, et al.: Osteonecrosis of the jaw in patients with metastatic breast cancer [abstract]. Breast Cancer Res Treat 2004, 88(Suppl 1): S131:3057.Google Scholar
  37. 37.
    Patchell PA, Tibbs WF, Regine R, et al.: A randomized trial of direct decompressive surgical resection in the treatment of spinal cord compression caused by metastasis [abstract 2]. Proc ASCO 2003, 22:2.Google Scholar
  38. 38.
    Chow E: Pain and structural effects of external beam radiotherapy. Cancer Treat Rev 2005, 31(Suppl 1):S20.Google Scholar
  39. 39.
    Coleman RE, Major P, Lipton A, et al.: Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the bisphosphonate zoledronic acid. J Clin Oncol 2005, 23:1–11. Data generated in patients with osseous lesions from cancer examining urinary NTx and serum BAP. Patients with medium to high urine levels of NTx (>50 nmol/mmol creatinine) had a signi ficantly increased risk of SRE and disease progression. This study concluded that NTx provides valuable prognostic information.CrossRefGoogle Scholar
  40. 40.
    Lipton A, Costa L, Ali SM, et al.: Bone markers in the management of metastatic bone disease. Cancer Treat Rev 2001, 27:181–185.PubMedCrossRefGoogle Scholar
  41. 41.
    Ali SM, Demers LM, Leitzel K, et al.: Baseline serum NTx levels are prognostic in metastatic breast cancer patients with bone-only metastasis. Ann Oncol 2004, 15:455–459.PubMedCrossRefGoogle Scholar
  42. 42.
    Brown JE, Cook RJ, Major P, et al.: Bone turnover markers as predictors of skeletal complications in prostate cancer, lung cancer, and other solid tumors. J Natl Cancer Inst 2005, 97:59–69.PubMedCrossRefGoogle Scholar
  43. 43.
    Vinholes J, Coleman R, Eastell R: Effects of bone metastases on bone metabolism: implications for diagnosis, imaging and assessment of response to cancer treatment. Cancer Treat Rev 1996, 22:289–331.PubMedCrossRefGoogle Scholar
  44. 44.
    Jaschke A, Bastert G, Solomayer EF, et al.: Adjuvant clodronate treatment improves the overall survival of primary breast cancer patients with micrometastases to bone marrow: a longtime follow-up [abstract]. Proc ASCO (Post-Meeting Edition) J Clin Oncol 2004, 22(14S):529.Google Scholar
  45. 45.
    Powles T, McCloskey E, Kurkilahti M: Oral clodronate for adjuvant treatment of operable breast cancer: Results of a randomized, double-blind, placebo-controlled multicenter trial [abstract]. Proc ASCO (Post-Meeting Edition) J Clin Oncol 2004, 22(14S):528.Google Scholar
  46. 46.
    Saarto T, Vehmanen L, Blomqvist C, Elomaa I: Ten-year follow-up of a randomized controlled trial of adjuvant clodronate treatment in node-positive breast cancer patients [abstract]. Proc ASCO (Post-Meeting Edition) J Clin Oncol 2004, 22(14S):527.Google Scholar
  47. 47.
    Coombes RC, Hall E, Gibson LJ, et al.: A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 2004, 350:1081–1092.PubMedCrossRefGoogle Scholar
  48. 48.
    Goss PE, Ingle JN, Martino S, et al.: A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med 2003, 349:1793–1802.PubMedCrossRefGoogle Scholar
  49. 49.
    Thurlimann B, Keshaviah A, Mouridsen H, et al.: BIG 1–98: Randomized, double-blind phase III study to evaluate letrozole vs tamoxifen as adjuvant endocrine therapy for postmenopausal women with receptor-positive breast cancer [abstract 511]. Proc ASCO 2005, 24:6S.Google Scholar

Copyright information

© Current Science Inc. 2006

Authors and Affiliations

  1. 1.Breast Cancer Medicine ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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